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A case study of homoeopathic management of acute bronchiolitis treated in an inpatient department setting
*Corresponding author: Dr. Gaurang Vivek Haralikar, Department of Homoeopathic Materia Medica, Dr. M.L. Dhawale Memorial Homoeopathic Institute, Palghar, Maharashtra, India. gaurangharlikar@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Mehta NS, Haralikar GV. A case study of homoeopathic management of acute bronchiolitis treated in an inpatient department setting. J Integr Stand Homoeopath. doi: 10.25259/ JISH_176_2025
Abstract
Acute bronchiolitis, characterised by lower respiratory tract inflammation, predominantly affects infants and young children, presenting a significant burden on healthcare systems worldwide. Among infants, those under the age of 1 year, particularly within the first 6 months of life, are at heightened risk for developing severe respiratory distress due to bronchiolitis. This respiratory condition commonly manifests with symptoms such as cough, wheezing, tachypnoea and respiratory distress, often necessitating hospitalisation and intensive medical management. Modern medicine management mainly involves supportive care; however, it does not focus on curative management. This case demonstrates how homoeopathic management, done at the right stage of the disease, can prevent further complications and cure it within the shortest time possible.
Keywords
Acute bronchiolitis
Homoeopathic management in acute bronchiolitis
Sambucus nigra
INTRODUCTION
Acute bronchiolitis is a viral lower respiratory tract infection that primarily affects infants under 1 year, with the highest vulnerability between 4 and 6 months of age. It is most often caused by respiratory syncytial virus and presents with cough, coryza, wheezing, tachypnoea and respiratory distress.[1] Due to the smaller calibre of infant bronchioles, even minor inflammatory swelling or mucus plugging can result in sudden respiratory compromise. Conventional management is largely supportive – utilising oxygen therapy, fluids and bronchodilators, but it does not offer a curative approach.
Homoeopathy, by contrast, provides an individualised therapeutic option based on the totality of symptoms, aiming for rapid and complete recovery. While reviewing the literature in the form of articles published on this topic, a solitary case report was found. The case report demonstrates the successful application of Arsenicum iodatum and sulphur in the case of bronchiolitis in an infant of 6 months of age.[2] However, apart from this, the role of homoeopathy in acute bronchiolitis, particularly in inpatient settings, remains under-documented. This case report illustrates the timely application of homoeopathy in an infant with bronchiolitis, leading to the quick resolution of complaints and the prevention of complications.
CASE REPORT
Patient information
A 5-month-old male infant was initially referred to our hospital due to his low socioeconomic background and was then admitted to our inpatient department setting from the casualty department. On admission, a detailed acute evaluation of the child was done [Table 1]. Table 1 gives a detail of the complaints of the patient in a location sensation modalities concomitant format.[3]
| Location | Sensation | Modality | Concomitant |
|---|---|---|---|
| 1. Respiratory system: O: Since 10–15 days, sudden P: Gradual F: On and off O: Since 1 day |
Coryza with watery white discharges and nasal blockage Cough+3: Sudden bouts of suffocative cough in episodes with nausea post-tussive vomiting and thick white expectoration+2 Difficulty in sucking at the breast. |
<Night+2, <draft of air+1 <Lying down+3 >When carried+2 >Erect posture>after expectoration+3 <Night+2 |
Irritable+3 during cough and playful when comfortable Profuse perspiration+2 and salivation |
| Reticuloendothelial system: 0: Since 1 day | Fever with chills | – | – |
O: Onset, P: Progress, F: Frequency
Feeding history: The child was accepting breastfeeding well before the acute episode started, but since the complaints started, breastfeeding has been reduced due to cough episodes
Birth history: Full-term normal delivery; baby cried immediately after birth and had no congenital anomaly
Mother obstetric history: G1 P1 A0 L1
No travelling history.
Clinical findings
General examination: G.C. good
Weight: 8 kg
Peripheral cyanosis only during the cough episodes. No pallor/oedema/lymphadenopathy/dehydration
Vitals: Temperature – afebrile
Pulse: 148/min
Respiratory rate: 34/min
SpO2: 96% at room air
Respiratory system examination: Intercostal retractions + and air entry equal with bilateral basal crepts
Cardiovascular system: Sound 1, sound 2 heard
P/A: Normal central nervous system – normal.
Blood investigations
7/12/23
Complete blood count: haemoglobin – 9.2
White blood cells (WBC) – 12800 (within normal limit for age)
Neutrophils/Lymphoytes/Eosinophils/Monocytes/ Basophils- 56/40/03/01/0
Platelet count – 248000
C-reactive protein – 0.92.
Diagnostic assessment
The primary symptoms are cough and coryza with white watery discharge, dyspnoea and fever. We can see that the pathology was initially restricted to the upper respiratory tract but has now moved to the lower respiratory tract. The most likely differential diagnoses were bronchopneumonia and acute bronchiolitis. To enable a final diagnosis, the patient was advised to have a chest radiograph [Figure 1]. The radiograph showed no consolidation patch or opacity in the lungs, confirming the diagnosis of acute bronchiolitis caused by an upper respiratory tract infection.[4] Furthermore, the WBC counts in the normal limits suggest that there are no signs of infection.
Determining the stage and prognosis of the condition
On applying the bronchiolitis severity assessment scoring scale, the respiratory rate was normal to slightly increased; the respiratory effort showed mild chest wall retraction, no supplemental oxygen was required as the saturation was maintained on room air, feeding was decreased and no apnoea was seen. Thus, this was a case of mild acute bronchiolitis [Table 2].[3]
| Parameters | Mild | Moderate | Severe |
|---|---|---|---|
| Respiratory rate | Normal to slightly increased | Increased | Markedly increased compared to normal values |
| Respiratory effort | Mild chest wall retraction | Tracheal tug, nasal flare, moderate chest wall retraction | Marked chest wall retraction, nasal flare and Grunting |
| Oxygen saturations | No supplemental oxygen requirement O2 saturations >95% | Saturations 90–95% | Saturations <90% may not be corrected by O2 |
| Feeding | Normal to slightly decreased | 50–75% of normal feeds | <50% of feeds, unable to feed |
| Apnoea | Nil | May have brief episodes | May have increasing episodes |
O2: Oxygen
Final diagnosis–mild acute bronchiolitis
The symptomatology of the patient was classified according to the homoeopathic symptomatology in Table 3.
| S. No. | Symptom | Classification |
|---|---|---|
| 1. | Irritable+3 during cough and playful when comfortable | Characteristic, mental concomitant |
| 2 | cyanosis only during the cough | Characteristic physical particular symptom |
| 3 | Cough <lying down+3 | Characteristic, physical, particular symptom with an aggravating modality |
| 4 | Cough <night+2 | Characteristic, physical, particular symptom |
| 5 | Cough <draft of air+1 | Characteristic, physical, particular symptom |
| 6 | Profuse perspiration+2 during cough | Characteristic, physical, general, concomitant symptom |
| 7 | Profuse salivation during cough | Characteristic, physical, particular symptom |
| 8 | Cough followed by vomiting | Characteristic, physical, particular symptom |
| 9 | Cough with thick white expectoration | Characteristic, physical, particular symptom |
The following totality of symptoms was made:
Irritable +3 during cough and playful when comfortable
Cough <lying down+3
Cough <night +2
Cough <draft of air+1
Profuse perspiration +2 during cough
Cyanosis +2 only during the cough
Profuse salivation during cough
Cough with thick white expectoration.
In this case, most of the symptoms were characteristic particulars. These symptoms were repertorised; however, the remedies in the results, including Pulsatilla and Nux vomica, did not cover all symptoms. Therefore, we referred to the Materia Medica directly, based on our knowledge of clinical Materia Medica and a few reportorial references [Table 4].[5-7] The remedy closest to the symptom totality was Sambucus nigra. S. nigra is one of the most prominent remedies for suffocative cough, especially in infants. Remedy differentiation was carried out among the three remedies as follows.
| Differentiating feature | Pulsatilla | Nux vomica | Sambucus nigra |
|---|---|---|---|
| 1. Sphere of action | Respiration | Respiratory organs | Respiration |
| 2. Onset and progress | Gradual onset with slow progression at the peak | Violent action | Sudden onset |
| 3. General mental state | Discouraged. Whining. Easily offended. Craves sympathy. | Irritable and hypersensitive, mentally. | Constant fretfulness. Fright followed by suffocative attacks. |
| 4. Respiratory symptoms | Profuse, bland, thick, yellow-green discharges; bitter mucus cough; dry hacking; expectorates bitter or salty as it loosens up. Air hunger; aggravated Lying on the left side | Tight, dry hacking cough; at times with bloody expectoration. Cough brings on a bursting headache and bruised pain in the epigastric region. | Paroxysmal, suffocative cough, coming on about midnight, with crying and dyspnoea. The child awakes suddenly. The child is suffocating, sits up and turns blue. Copious loose secretions. Sweats or gets short of breath. |
| 5. Modalities | Aggravation – Warmth: Air Room Getting feet wet, Suppression, Evening Rest Beginning motion Lying; one side (L) AMEL cold, fresh, open air Uncovering Erect posture. Gentle motion |
Aggravation – Early morning, Cold open air, Drafts of air, High living: Coffee, Mental exertion, Anger, noises Amelioration – Free discharges Naps Wrapping head. |
AGG-dry cold air cold drinks, while heated, Head low, eating fruits, lying down and resting AMEL – Motion, wrapping up and sitting up in bed |
PTV: Post-tussive vomiting, RR: Respiratory rate, SpO2: Oxygen saturation, AMEL: Amelioration, AGG: Aggravation.
Final remedy: S. nigra
Based on the above Materia Medica differentiation, it is evident that S. nigra perfectly fits our case, as it has marked action on respiratory organs with the following symptoms: Paroxysmal suffocative coughs, the child awakes suddenly and suffocating, night aggravation, lying down aggravation and irritability of mind.
Final susceptibility
The patient’s susceptibility was high, requiring frequent repetition of the remedy.
Reasons
High number of characteristic symptoms, high level of sensitivity and structurally reversible and rapidly progressive pathology.[8]
In this case, the pathology progressed rapidly, so the medicinal force should match its pace. Thus, more frequent repetitions in high potency are necessary. However, this poses the risk of unnecessary aggravation. For such cases, Dr. Hahnemann, in the 5th edition of the Organon of Medicine, Aphorism 286, states that the medicine can be repeated frequently but in water doses in a deviated manner. Through water doses, the medicine comes in contact with a much larger surface of sensitive nerves and thus generates a larger response to the medicinal action.[9]
Final remedy and posology: S. nigra 200 1st dilution every 4 h.
Homoeopathic follow-up score according to the Naranjo scale in this case, 10/12, indicates effective treatment and a positive outcome [Table 5].[10]
| Domains | Yes | No | Not sure | Assessment in this case |
|---|---|---|---|---|
| Was there an improvement in the main symptom or condition for which treatment was given? | +2 | +2 | ||
| Did the clinical improvement occur within a plausible time frame relative to medication intake? | +2 | |||
| Was there an initial aggravation of symptoms? | 0 | |||
| Did the effect encompass more than the main symptoms? | +2 | |||
| Did overdoing all well-being improve? | +2 | |||
| The direction of the cure: did some symptoms improve in the opposite order of development? | 0 | |||
| Was the improvement confirmed by any objective evidence? | +2 | |||
| Did repeat dosing, if conducted create similar clinical improvement? | +2 |
Follow-ups and outcomes
Follow-ups and outcomes are provided in Table 6.
| Hours | Irritability (%) | Activity | Feeding | Fever spike | Dyspnoea | Cough | PTV | Salivation | Respiratory rate and saturation | Action taken |
|---|---|---|---|---|---|---|---|---|---|---|
| 24 h | >50 | Playful | Improved by 50% | No | >50% | Cough is present but better in frequency and intensity | 1 episode with sticky cough | Reduced | RR 36/min SpO2-94% at room air | Sambucus 200 1st dilution 4 h |
| 48 h | >80 | Playful | Normal | No | None | No cough present | Nil | Nil | RR 30/min SpO2 96% at room air | Sambucus 200 1st dilution 4 h |
| 72 h | Nil | Playful and cheerful | Nil | Nil | Nil | Nil | Nil | RR 35/min SpO2 97% at room air | Sambucus 200 thrice a day for 2 days and discharge |
PTV: Post-tussive vomiting, RR: Respiratory rate, SpO2: Oxygen saturation
DISCUSSION
This patient presented with various complaints suggestive of acute bronchiolitis. This case demonstrates the effective management of such patients purely with homoeopathic intervention done at the right point of time in the course of the disease. With standard modern medicine, acute bronchiolitis requires 3–7 days to be cured.[1] However, this case illustrates the speedy recovery of the child as the inflammation of the bronchioles has started settling within 24 h of the administration of the remedy, which is indicated by the improved feeding of the child. Later, within 48 h of the administration of the remedy, the child had almost recovered from the acute episode with some residual irritability only and the child was then just kept under observation for the next 24 h for monitoring. It is possible to shorten this period considerably with a well-selected homoeopathic simillimum. It also throws light on effective homoeopathic management strategies where the selection of medicine was made from the well-known acute class of medicines and explains the selection of potency by assessing the patient’s susceptibility and repeating the medicine in water doses judiciously to match the disease pace. This case report also demonstrates how homoeopathic intervention effectively cures the case in the shortest time and that too at a very low cost as compared to conventional treatment. It is also important to assess the homoeopathic follow-ups based on the Naranjo scale to avoid subjectivity and to provide proof of the effectiveness of homoeopathic medicines.
Since this is a solitary case report, the findings of this report have to be confirmed by randomised controlled trial studies or by case series studies that demonstrate and highlight the scope of homoeopathy in these cases.
CONCLUSION
There is a strong misconception among the general public that homoeopathy is not effective in acute cases and is effective only for chronic diseases. Homoeopathy also provides a cost-effective solution for acute bronchiolitis, which reduces the economic burden of health care on economically disadvantaged populations. Although this case report emphasises the scope of homoeopathy in such serious conditions, it is a solitary case report, and more such case reports researching this field are necessary.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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